Provider Demographics
NPI:1730987785
Name:CONNOR, PAMELA (CLINICAL NUTRITIONIS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:
Credentials:CLINICAL NUTRITIONIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 E ROSEVILLE PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7975
Mailing Address - Country:US
Mailing Address - Phone:916-404-0886
Mailing Address - Fax:
Practice Address - Street 1:1891 E ROSEVILLE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7975
Practice Address - Country:US
Practice Address - Phone:916-404-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist